Effectiveness of Point of Care System (POC)

Effectiveness of Point of Care System (POC) TITLE Effectiveness of Point of Care System (POC) in Decreasing Hospital Shouldered Costs for Health Care of Indigent Patients. AUTHORS Seurinane Sean Espanola MD (Principal Investigator), Ma. Elinore Alba-Concha MD (Co-author) INTRODUCTION Topic Background: The National Health Insurance Act of 2013 Section 6 states that all citizens of the Philippines shall be covered by the National Health Insurance Program prioritizing acceleration of provision of health services to all Filipinos especially those who cannot afford such services. All indigents not enrolled in the program shall have priority provided that they shall be subsequently enrolled in the program.1 It has been estimated that 77 million of more than 92 million Filipinos are covered by PHIC as of March 2009. And 72 percent of the 4.7 million indigent families are enrolled in the sponsored program.2 R.A. No. 7875 targets 100 percent coverage of the indigent population3 but despite national government appropriations, sin tax collections, local government sponsorships and other sources, a vast number of poor are not yet covered by PHIC hence a mechanism of enrolling these patients at the Point of Care was established to ensure that all poor that is in dire need of quality health services is covered by Philhealth. The Point of Care (POC) system will provide indigent patients or those belonging to Class C-3 to D availment of Philhealth benefits.4 Ensuring access of the less privileged members of society to health care is the main aim of the POC system and the additional aim is to offset hospital shouldered costs of free services to the uninsured hence assuring sustainability. This study then focuses on the latter and looks into the initial effects of the POC system on hospital shouldered costs. REVIEW OF RELATED LITERATURE: Health care for all is a seemingly profound undertaking providing medical assurance for people from all walks of life however the question of sustainability and accessibility is still an ongoing issue. Despite the improving economy and work force, health care continues to remain less of a priority as finances are being concentrated to the basic needs of life. In a study by Tsilaajav in March 2009 focusing on costing study for selected Philippine hospitals, the average unit cost of outpatient visit is P378 while emergency visit is P552. The average inpatient discharge on tertiary public hospitals would range from 1,500 to 10,000 pesos.5 This considerable amount is threatening to low income families compromising their general health. There are several types of Insurance systems in the Philippines. Private health insurances works by giving coverage separately for hospitalization as well as emergency cases however premiums may be costly. Health Maintenance Organization (HMO) which is the common managed care plan in the country covers basic medical expenses from preventive and outpatient setting aside from hospitalization. And the Philippine Health Insurance Corporation (PHIC), reinventing consumer payment schemes since the establishment of Medicare, provides affordable health insurance for Filipinos at any age. Although these insurance systems may come free during employment, still there is a higher chance of discontinuity especially for those with average to low monthly incomes. And as insurance premiums may rise exponentially yearly, many of the insured in return will become uninsured. The uninsured or people with no insurance coverage are no different from those insured. They are struck with common diseases however receiving less preventive care and screenings foregoing medical care due to costs leading to higher mortality rates.6 Hence the government plays a pivotal role in providing access to medical care for everyone. The Aquino administration aims to provide accessible and available health services for all Filipinos through its Universal Health Care also referred to as Kalusugan Pangkalahatan. A health care that is accessible, efficient, equitably distributed, adequately funded, fairly finance and appropriately used by all. However despite efforts of the government to provide easy access to care especially to the poor, still there are vast majority who are uninsured hence faced with unaffordable medical bills during admissions, more out of pocket expenditures and with these thoughts in mind would later forego care because of costs and may defeat the purpose of the government of providing financial risk protection for all especially the poor. The PHIC last November 17, 2013 with Joint order No. 2013-0033 implemented the Point of Care Enrollment Program for Hospital-Sponsored Members to further strengthen the Aquino administration program of universal health care more so focusing on the indigents as stipulated on Republic Act 7875 which clearly mentions all indigents not enrolled in the program shall have the priority in the use and the availment of the services and facilities of government hospitals. 1 The Point of Care System caters to non-member who were assessed by the Medical Social Worker as class C-3 and class D and members who are not covered due to lack of qualifying contribution and classified as class C-3 and D. Patients enrolled under the POC will be covered with in and out patient benefits including the no balance billing policy. The premium amount will be shouldered by the hospital and the coverage of Hospital Sponsored Membership shall be from the first day of confinement month and shall end on the last day of the same calendar year. Sponsorship will be continued by the National Government if the applicant remains in the same class per year upon re-evaluation. Thru Point of Care System patients will be given enough benefits and be more confident in utilizing health care services without being burden of the costs and in return lessens the quality fee services and out of pocket expenditures and more importantly improve hospital reimbursements. However up to date this new system does not have local level analysis and there are no comprehensive studies up to date hence this study. RESEARCH QUESTION: The National Health Insurance Act through the National Health Insurance Program ensures health coverage for all. The point of care system covers class C-3 and D admissible or admitted patients. However to date there is still yet to be a study providing a local level analysis of the impact of Point of Care system. Additionally, it is still unknown how the system will impact the financial status of hospitals and its sustainability issues. Thus this research aims to answer the question: Will the POC implementation reduce hospital shouldered health care costs for indigent patients? SIGNIFICANCE OF THE STUDY: The Point of Care system has had an immediate effect on healthcare institutions and subsequently the health coverage. It aims to provide financial risk protection to all Filipinos especially the poor as implemented through the Aquino Agenda. As quality of patient healthcare is directly tied to the sustainability of hospitals, the point of care system will affect the finances and decision-making of hospitals and will directly determine whether or not financial risk protection for the poor is in fact being achieved. Hospitals will be able to identify the areas of concern and areas of growth the point of care will be providing regarding efficiency and sustainability and in return will encourage low-income patients to avail the system. OBJECTIVES: The general objective of this study is to compare hospital shouldered costs for patients admitted for common conditions seen in Family Medicine pre and post Point of Care. Specifically, based on secondary data provided by the Southern Philippines Medical Center, the study shall: 1. describe patients admitted in Southern Philippines Medical Center from June 1, 2013 to March 31, 2014 in terms of a) demographic characteristics (age, sex, address) b) diagnosis c) MSW classification d) other external sources of health funds (CMAP, Lingap) e)length of hospital stay 2. compare the hospital revenue pre and post POC 3. compare hospital shouldered costs pre and post POC which includes cost of POC enrollment and additional subsidy on top of PHIC and other external sources’ reimbursement. 4. compare the hospital revenue pre and post POC. METHODOLOGY Research Design Retrospective Cohort Setting Southern Philippines Medical Center, Retrospective date covering June 2013 to March 2014 Inclusion The Department of Family Medicine caters to patients aged 14-60 years old only. Hence patients who fall on the age bracket admitted with following diagnosis AGE with moderate, DHF I, CAP moderate risk or PCAP-C enrolled in the point of care system and age group and diagnosis matched patients without insurance admitted for the said conditions that were not enrolled in POC will be included. Exclusion Charts and bills that could not be retrieved DEFINITION OF VARIABLES Age – refers to the chronological age of the admitted patient. Sex – refers to the biological sex of the admitted patient. Address – refers to admitted patients dwelling area. Philhealth Insurance Status – refers to patients PHIC membership status. Diagnosis – refers to patients identified cause of admission. Total Hospital Bill – refers to the total amount incurred during length of hospital stay. Total Out-of-Pocket Payment – refers to the amount paid by the patient not subsidized by insurance provider. Philhealth Reimbursement – refers to the amount refunded by the Philhealth Insurance System. Total Hospital Subsidized Costs – refers to the amount shouldered or written off by the hospital after PHIC reimbursement, reimbursements from external sources (CMAP/PDAF) and total out of pocket payments have been deducted from the total hospital bill. It would be computed as Total Bill – (PHIC Reimbursment + External Sources Reimbursement + Out of Pocket Payments.) Data Gathering Data gathering will commence as soon as approval from the DOH XI CERC is obtained. The principal investigator will gather the data using the charts and billing statements as the source and transcribe this in the data collection form seen in Appendix A. Charts will be gathered and will be segregated according to diagnosis and be separated as to with or without POC. Variables will be collected as follows: Variables Independent variables 1. Demographic data (age, sex, address) 2. Diagnosis 3. MSW classification 4. Other external sources of funding 5. length of hospital stay Main outcome measures and other dependent variables The main outcome measure for this study is the Total Hospital Subsidy given for pre and post POC patients. Other outcome measures of interest include the total hospital bill for pre and post POC patients, the PHIC reimbursements, and the total out of pocket payments and the reimbursement from external sources. The total out of pocket payment and total hospital subsidy, if not reflected from the total bill, will be cross checked from the database of cashier section or lingap using the patients complete name or hospital number. The co-author can randomly check the transcribed data with the original data sources to ensure data integrity. Data Analysis Data will be encoded in excel format and will be analyzed using Epi Info version 7.0. Descriptive statistics will be used to summarize data. Comparison of continuous variable will be made using the t test and categorical variables will be compared using the chi-square test. Mean Total Bill – Gross Total Bill / Number of Admitted Patients under FM Mean Amount Reimbursed by PHIC – Gross Total Reimbursement/ Number of Admitted Patients under FM Mean Patient Out of Pocket Payments – Gross Out of Pocket Payments / Number of Admitted Patients under FM Mean Hospital Subsidy – Gross Total Subsidy / Number of Admitted Patients under FM Gross Total Bill – Total Bill of all Admitted patients under FM Gross Philhealth Reimbursement – Total PHIC Reimbursement of all Admitted patients under FM. Sample Size Calculation Using the following assumptions: alpha = 5 (two-sided) power = 80 m1 = 3000 m2 = 2500 sd1 = 800 sd2 = 800 n2/n1 = 1 A total of 82 participants (41 without and 41 with POC) per disease entity will be required for this study having a sum total of 246 patients. Estimates were made using the standard 5% alpha error and 80% power since there were no previous studies for reference. ETHICAL CONSIDERATIONS Ethics Review The protocol of this research will be submitted for approval to the DOH XI Cluster Ethics Review Committee. Privacy Patient data will be anonymized prior to analysis. No personal contact with individual patients shall be made. Confidentiality Patient data for analysis will be anonymized. How will you keep the data and for how long? After initial analysis, the anonymized data will be stored electronically and will be retained for 5 years from the time of initial analysis under the custody of Dr. Seurinane Sean Espanola and Ma. Elinore Concha. Within this retention period, the investigators listed in this protocol may refer any number of times to the data for clarification, further analysis and/or re-analysis. How will you discard/dispose of the data? After the 5-year retention period, the electronic data will be permanently deleted. Who can access data? Only the investigators listed in this protocol will be given access to the raw data for reference and initial or subsequent analysis. Extent of use of study data Data shall be used solely for the objective of analysis of the Point of Care System, as stated in previous sections of this protocol proposal. No facts or information shall be released without the prior consent of the medical director of the hospital. Necessary steps shall be taken to assure that this information will not be made accessible to persons outside of the research team. Authorship and contributorship a. Who are the authors or contributors to the present paper? The authors and contributors to this study shall be given proper recognition in the formulation of the follow-up paper. Authors and Co-authors include Dr. Seurinane Sean Espanola and Dr. Ma. Elinore Concha respectively b. Acknowledgment of original data collectors Proper acknowledgment shall be given to the Southern Philippines Medical Center for original data collection. c. Written consent of original data collectors that the data can be used for further research Written consent for use of secondary data shall be requested from Dr. Leopoldo J. Vega, the Chief-Of-Hospital. Conflicts of interest The author and co-author hereby declare that they have no conflicts of interest. Publication Publication shall be pursued at the onset of writing of the paper for this study. Submissions shall be sent to relevant publishers who can help promote the awareness of this topic. Funding Dr. Seurinane Sean Espanola is presently seeking funds to cover the expenses for this research. Dummy Tables DUMMY RESULTS Table 1. Comparison of Baseline Characteristics *using t-test **using chi-square test Table 2. Comparative parameters between POC and pre-POC PhilHealth – sample (Note: separate tables will be made for the other medical case rate diagnoses) BUDGET Administrative expenses and supplies For office supplies and support expenses as requested by the Health Sciences Program. Funds would go towards providing computer and office space and travel if needed. TIMETABLE References 1. Philhealth. November 7, 2013 Manual of Operations and Procedures for the Implementation of the Point of Care Enrollment Program for Hospital-Sponsored Members. (Philhealth Joint Order 2013-0033) PHIC, Pasig. 2. Philhealth at a Glance. The National Health Insurance Program. Senate Economic Planning Office. November 2009. 3. Philhealth. October 14 2013. Implementation of the Point of Care Enrollment Program (Philhealth Circular 0032-2013). PHIC. Pasig 4. Philhealth. March 26, 2013. Enrollment of the Critical Poor under the Sponsored Program of the National Health Insurance Program at Point of Service. (DOH Department Order/Philhealth Office Order2013-0031). PHIC, Pasig. 6. The Kaiser Commission on Medicaid and the Uninsured. September 2013. Key Facts about the Uninsured Population. APPENDIX A POC Study Data Collection form Patient’s Initials: ______________________________________________ Hospital Record number: _________________________________________ Age: ______Sex: __Male __Female Diagnosis: ______________________________________________________ MSW Classification: __C3__D Date Admitted: ________________Date Discharged: ______________ Detailed Hospital Bill (attach if possible) 1

Location options for retail and service businesses

INTRODUCTIONA firm location of determines how it operates and what factors hinder or enabling the firm to operate effectively. Localization of industry is beneficial in many instances, and at the same time has its demerits. Concentration of businesses service in the same location gives firm economies of externalities. These externalities come in form of backward linkages to the services from other firms, pulling a training school for manpower development and workers training.ADVANTAGES AND DISADVANTAGES OF LOCALIZATION OF FIRMSAdvantages of Central Business District include:I. Encourage the development of supportive service centers;ІІ.   Access to high skilled labors;ІІІ. Access to operational tools and spare parts;ІV. Access to modern technology and information technology;V. Encourage development of common training centers for staffers and clients orientation.Disadvantages of locating a service firm in a business district include:I.   Increase in   comp etition level among service firms;II.   Increase in cost of operation due to congested industry and business district.Advantages of Neighborhood locationІ. Having opportunity to get feedback from customers and clients;ІІ. Easy advertisement of services to clients;ІІІ.   Personal services are easily tailored to client taste.ІV. Assess to raw material for retail stores.Disadvantages of Neighborhood locationІ.   Service provision are restricted to those in the neighborhood;ІІ.  High cost for introducing new technology and workforce training.Advantages of Shopping Centers and Malls locationІ.  One time shopping is easily carried out by customers;ІІ.  Attraction of different categories of customers are encourages   due to product and services differentiationDisadvantages of Shopping Centers and Malls location:І.   Shop lifting are easily carried out due to many differentiated products;ІІ.  Customers may be tempted to buy the wrong product due to plethora of appealing products in the   window dressing;Advantages of store near competitors:І.  Ã‚   New strategy and business idea are learn from rivals;ІІ.  Ã‚   Cost reduction are reduced due to the competition among firms;ІІІ.   Raw materials are easily accessed;ІV.  Ã‚  Innovation are encouraged due to healthy competition among firmsV.     Encourage introduction of modern technologyDisadvantages of store near competitors:І    Organization strategies are counterpart thereby rendering the operations ineffective;ІІ    Unhealthy competition leads to blackmailing and sabotaging activities against rivalsAdvantages of outlying areasІ       Proper structure and market planning is encouraged;ІІ      Ã‚  Easy transportation of goods are enabledІІІ       Easy location of service and goods to an outletDisadvantages of outlying areasІ      Few operat ors are encouraged in the market which results in price hike;ІІ    Customers cannot make all service shopping in one location.Advantages of Home based location:І      Backward linkage to local raw materials is encouraged;ІІ      Cheap labor and cost reduction is easily accessed;ІІІ    Local taste and culture is easily recognized and upheld  Disadvantages of Home based locationІ      Varieties of product and service are restricted due to local taste and wants;ІІ       Difficulty in introducing new technologiesCONCLUSIONThe location of retail or service businesses influences how well such firm operates. The location may  Ã‚   result in the advancement of the business operations or may hinder it depending on the location and business type. It is then germane that adequate assessment is conducted to weigh the pros and cons of a place where a business would be located in order to derive maximum advantages.

Student’S Name. Professor’S Name. Course. Date.Effect Of

Student’s Name Professor’s Name Course Date Effect of Climatic Change on the Cryosphere Introduction The tale of the human race and our connection to the ecosystem can be viewed as an unfolding adventure shrouded in mysterious occurrences. The impacts of the overall climatic change have signaled danger for a long time, and it is clear that there is a global crisis facing us. One would wonder where we are headed and if the earth will be able to sustain life in the next century. Global warming continues to manifest itself to us every day through rapid changes occurring to the climate system. Some of us still hide from reality and hold on to the notion that climate change is just, but another scientific†¦show more content†¦When carbon dioxide and other toxic gasses are released into the atmosphere, they become too excessive for all the vegetation to absorb. Such conditions lead to the over-accumulation of gasses that form a layer called a greenhouse. The gasses create a greenhouse effect that prevents any heat from escaping the earth (Taylor,881). This means that most of the heat being released from the earth’s center as well as that being absorbed from the sun is retained within the atmosphere. The trapped heat has over time led to the rise in global temperatures which has subsequently had adverse effects on the ecosystem. In essence, the small changes to a temperature that have occurred on a global scale over time can lead to significant and human threatening changes in the global weather patterns. The contemporary warmth has been exhibited by melting ice lands and glaciers as well as increased floods and famines. Driving forces of this climatic change Scientists attribute a huge percentage of the gas accumulation to the human activities using fossil fuels and whose operation leads to the release of significant amounts of carbon dioxide and other toxic gasses into the air. The rate of temperature rise since the industrial revolution shows a significant change of 38% due to the constant emission of toxic gasses from human activity (Lonnie, 1 53).

The Rape Myth Embedded Within Society Preventing Women...

Women have always struggled in the fight to gain equality with men, despite the many advances, society still has a long way to go in addressing the issue of gender inequality. One major factor that keeps women from achieving gender equality is the many rape myths that are associated with sexual assaults. The rape myths that are deeply embedded within the Canadian legal system and society continues to have a detrimental effect on women. Using the R. v. Ewanchuck case I argue that the rape myths embedded within society prevent women from gaining justice within the legal system. R. v. Ewanchuck is a case about a 17-year-old woman who was sexually assaulted by Steve Brian Ewanchuck after what was ostensibly a job interview for a position in his woodworking business (Du Mont Parnis, p.82). Following the interview in Mr. Ewanchuck’s van, which was parked outside an Alberta mall, he asked the woman if she would like to see a sample of his work in the attached trailer, to which she agreed. Despite Mr. Ewanchuck’s professional attitude during the interview, the complainant still felt uneasy toward him so upon entering the van she left the door open. After following her into the trailer Ewanchuck had closed the door and by doing so alarmed the complainant (Supreme Court of Canada, 1999). Once in the trailer, Mr. Ewanchuck proceeded to continuously initiate several incidents that involved touching the complainant sexually, even though the complainant clearly said â€Å"no†. When the caseShow MoreRelatedEpekto Ng Polusyon19213 Words   |  77 PagesHow women Move On From Violent Relationships Researcher: Carole Le Darcy Supervisor: Dr Sue Becker Acknowledgements I would like to express my sincerest thanks and gratitude to all of the exceptionally strong women that participated in this research that have freely given not only some of their precious and valuable time but have also revealed that which is sadly all too often concealed; the remarkable, courageous and often very moving accounts of their experiences, journey and exit from abusiveRead MoreOne Significant Change That Has Occurred in the World Between 1900 and 2005. Explain the Impact This Change Has Made on Our Lives and Why It Is an Important Change.163893 Words   |  656 PagesUnnatural Acts: Charting the Future of Teaching the Past Sharon Hartman Strom, Political Woman: Florence Luscomb and the Legacy of Radical Reform Michael Adas, ed., Agricultural and Pastoral Societies in Ancient and Classical History Jack Metzgar, Striking Steel: Solidarity Remembered Janis Appier, Policing Women: The Sexual Politics of Law Enforcement and the LAPD Allen Hunter, ed., Rethinking the Cold War Eric Foner, ed., The New American History. Revised and Expanded Edition E SSAYS ON